Melanie Rizzoli
It is one of the least studied and analyzed malignant tumors by the world of Italian research, despite the approximately 14 thousand new diagnoses a year, the majority of which always arrive late, when the cancer is now in an advanced stage and has spread locally and remotely. Pancreatic cancer is one of the most subtle and dangerous oncological pathologies, because this large gland is located deep in the abdomen, placed behind the stomach, leaning against the spine and disguised as the liver and colon, and above all because it does not manifest, at least initially , clear and recognizable symptoms. Furthermore, no obvious risk factors have been identified, apart from being overweight, smoking, a diet rich in fat and family history, but none of these is officially recognized as the triggering cause and many people who get sick with this pathology do not have none of these factors, as vice versa many of those who are affected by it will never fall ill with this disease. Today pancreatic cancer has made headlines on emotion due to the sad story of the footballer Gianluca Vialliwho survived just over 5 years, as happened previously following the death from the same pathology and post-operative course of Luciano Pavarotti e Steve Jobs (they too arrived at treatment with a late diagnosis), but many famous and non-famous people have faced and lost their lives due to this tumor, now classified as the fourth cause of death, with a 5-year survival of just 8% of patients.
The pancreas is responsible for producing pancreatic juices that aid in the breakdown of food and subsequent digestion, as well as producing vital hormones such as insulin to control blood sugar levels, so the initial symptoms are subtle and misleading for an early diagnosis , confuse both the patient and the doctor, ranging from difficulty in digestion with weight loss, to pain in the upper abdomen, above the navel, and back, pain that does not change by changing position, is constant and can be from mild to violent, up to jaundice, or the yellow coloration that starts from the sclerae of the eyes and then spreads with a constant itch to the whole skin of the body, which causes the production of dark marsala-colored urine and pale stools, this is a sign due to obstruction by the tumor of the pancreatic bile ducts which pour the digestive serum into the blood instead of into the intestine as usual. Sometimes diabetes can occurwhen the pancreatic compromise is already extensive and the tumor mass has invaded a large part of the organ, which can also cause episodes of acute pancreatitis, a very painful inflammation with abdominal colic that almost always requires hospitalization.
To date there are no screening tests useful for the evaluation of subjects who do not present symptoms or alterations in laboratory data, because pancreatic cancer can be suspected with a very accurate ultrasound, or be identified radiologically with CAT scan, endoscopic ultrasound, or MRI (nuclear magnetic resonance), radiological tests that are generally not requested by apparently healthy patients.
Malignant tumors of the pancreas are different in area of onset in the gland (head, body or tail) and histology, and range from neuroendocrine to gastrinoma, as well as those that compromise the hormonal production of somatostatin, glucagon or insulin, very little symptomatic, but the most frequent of all is precisely pancreatic adeno-carcinoma, which initially, for still unknown reasons, would almost always induce a lowering of mood and signs of depression, before showing the typical symptoms of the disease. Pancreatic cancer is slowly but steadily increasing in the Italian population, parallel to that of the brain, and the causes are not known, but it affects individuals of all ages, from 20 to 100 years, even if the incidence is greater over 65 years, it progresses more or less quickly depending on the its histological aggressiveness (and not based on the age of the patient) and the elective therapy remains the surgical one, associated with the already known oncological and immunological medical treatments available today.
In the Lombardy Region, the Councilor for Welfare Guido Bertolaso two days ago it announced a working group on the “Pancreas Units” involving all the Research Centers of excellence in Lombardy, including the IEO (European Oncological Institute), coordinated by a single direction from the top management of the department, to build a network of exchange of clinical, medical, diagnostic information and research data, to ensure that it is possible to arrive at a method of prevention and early diagnosis, as well as a targeted therapy, a strong and clear signal of a “task force ” Lombard so far absent throughout Europe. In Lombardy alone, there were 4,031 new diagnoses of pancreatic cancer in 2019, 3,529 in 2020 (year of Covid), 3,444 in 2021, and the Region will make additional funds available to optimize the efforts of this important organizational model, which we hope will as a forerunner also in the other Italian regions, to identify and defeat in time this pathology still considered invincible.